Understanding And Managing Borderline Personality Disorder (BPD)
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
- For those experiencing suicidal thoughts, please contact the 988 Suicide & Crisis Lifeline at 988
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- For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-4357
Around five million people with borderline personality disorder (BPD) are estimated to be living in the United States. Personality disorders are characterized by ways of seeing and reacting to others that can cause interpersonal and behavioral problems in life and relationships. Common signs of borderline personality disorder, in particular, include emotional instability and difficulty maintaining healthy connections with others. People with this condition may feel happy and positive and then sad and depressed a few hours later. Learning more about the treatments available for borderline personality disorder, such as dialectical therapy, may help you make an informed decision on your mental healthcare.
What is borderline personality disorder (BPD)?
Borderline personality disorder is a personality mental illness characterized by challenges controlling emotions that may cause significant disruption to a person's life during adolescence and young adulthood. Changes in regions of the brain involved in impulsivity, emotion control, and aggression may contribute to this condition.
According to the National Institute of Mental Health, challenges related to emotional control may impact self-esteem, and self-image issues, increase impulsivity, and negatively impact close relationships. Without treatment, people who are borderline personality disorder may experience depression, dangerous risky behavior (such as reckless driving), thoughts or actions related to self-harm, substance abuse, and/or suicidal behaviors and/or thoughts.
A 2018 study suggests there are common risk factors believed to lead to BPD. Neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma may put you at a higher risk.
What causes BPD?
A 2018 study found that common factors believed to lead to BPD included brain abnormalities, genetic and environmental factors, and a history of childhood trauma.
How is Borderline Personality Disorder (BPD) diagnosed?
Borderline personality disorder is often diagnosed and treated after age 18. This is because an individual’s personality typically evolves so significantly throughout childhood and adolescence that providing an accurate diagnosis of a personality disorder in these phases of life can be difficult. Many children or teens who will go on to receive a borderline personality disorder diagnosis as adults may be initially diagnosed with depression or anxiety in their younger years. A licensed mental health professional can diagnose the condition through interviews and observations of both the individual and family history.
Therapists and psychiatrists typically look for the following symptoms when considering a diagnosis of borderline personality disorder and other mental disorders:
- A fear of abandonment
- Emotional pain related to actual or imagined loss of significant relationships
- Unstable emotions and/or challenges controlling intense emotions
- Unstable self-image
- Traumatic life events
- Intense and unstable relationships with friends and family members
- Self-destructive relationship habits
- Difficulty holding a job for an extended period
- Risky, impulsive behavior like unsafe sex or uncontrolled spending
- Self-harm
- Suicidal thoughts
- Difficulty managing stress
- Intense anger and/or irritability
- Dissociation (feeling "out of your body")
- Rapid mood swings
- Significant stress-related paranoia
- Ongoing feelings of depression or anxiety
- Feeling persistently bored or empty
- Challenges understanding one's identity or personality
- Cycling patterns of recognizing and denying the value of one's relationships often referred to as "splitting"
Developing borderline personality disorder (BPD) may also occur alongside another mental health condition, including the following:
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Complex post-traumatic stress disorder (C-PTSD)
- Sleep disorders
- Eating disorders, including binge eating
- Depression
- Substance use disorders
- Suicidal behavior
- Bipolar disorder
- Narcissistic personality disorder (NPD)
What treatments are available for BPD?
Psychotherapy, or talk therapy, is considered the cornerstone of BPD treatment according to the National Alliance on Mental Illness (NAMI). A comprehensive health treatment plan for borderline personality disorder may include a combination of psychotherapy and specific work to repair social factors alongside a clinical social worker or other mental health professionals. A mental health provider may also recommend medication to help manage severe symptoms in some cases. Do not start, stop, or change any medication without consulting a psychiatrist or other healthcare provider who can manage your psychiatric management plan. Types of therapy that are commonly recommended for those who develop borderline personality disorder (BPD) are listed below.
Dialectical behavior therapy (DBT)
Borderline personality disorder is often treated through DBT, which is a form of cognitive-behavioral therapy (CBT) focused on the impact of your beliefs, thoughts, and behaviors, emphasizing mindful living and acceptance to manage symptoms. This type of therapy (DBT) is usually a structured program that involves a workbook, worksheets, and frequent sessions. It can be done in an individual or a group therapy format and was developed specifically to treat borderline personality disorder by Dr. Marsha Linehan. It involves four modules, including:
- Emotional control
- Distress tolerance
- Mindfulness skills
- Interpersonal effectiveness
The authors of a journal publication on DBT for borderline personality disorder state that "dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in borderline personality disorder but also in other disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders."
Family therapy
Borderline personality disorder symptoms may lead to distress within a family dynamic. Family therapy can be a potential long-term therapeutic plan for individuals such as parents, siblings, partners, or mothers with borderline personality disorder who often feel emotionally unstable and experience difficulty maintaining healthy relationships. Through family counseling, individuals with borderline personality disorder and their immediate family can meet with the therapist together to discuss behavioral and emotional interventions and learn healthy coping skills and communication strategies.
Humanistic therapy
Humanistic talk therapy centers on a person's individual nature and goals instead of approaching every client in the same way. Sessions focus on positive behaviors and traits and developing the person's ability to use instincts to build positive patterns. The humanistic approach to therapy can foster a trusting relationship between a therapist and their client.
Schema therapy can be effective for people with other personality disorders who may not respond to other treatments as it’s a combination of elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, or a pattern of unwanted thoughts, to reduce self-destructive behaviors that may have developed during childhood.
Cognitive-behavioral therapy (CBT)
Cognitive behavioral therapy is backed by significant research suggesting its effectiveness in treating various mental health conditions, including borderline personality disorder. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to shift them.
Mentalization-based treatment (MBT)
Mentalization-based therapy (MBT) centers on increasing your curiosity and ability to accurately identify your emotions and thoughts and form a realistic expectation of others' thoughts. Researchers suspect that difficulties with mentalization may result from challenges during the early attachment phase of development in childhood.
Transference-focused psychotherapy (TFP)
Researchers believe that TFP treatments may help those with borderline personality disorder (BPD) who experience a split optimistic and pessimistic view of themselves and their primary caregiver due to excessive childhood aggression. TFP aims to merge the positive and negative perspectives to form a realistic view of the self and others.
Coping with BPD
In addition to working with your mental healthcare provider to develop a plan to treat specific symptoms, there are various coping skills and lifestyle changes you might use to manage your symptoms and adjust to living with borderline personality disorder, including the following:
- Journaling
- Building distress tolerance
- Practicing mindfulness
- Identifying accountability
- Working self-focused time into your routine
- Practicing yoga or other forms of calming movement
- Distracting yourself with sensory stimulation
- Not assuming intentions
- Caring for your physical health
- Taking walks in nature
Another skill that can be developed through DBT, radical acceptance, may also be beneficial. With this skill, you can learn to accept situations and emotions that seem challenging—especially those that are or impossible to change.
Tips for supporting a loved one with BPD
If someone you love has been diagnosed with borderline personality disorder, there are several ways you can support them, including the following:
Learn about borderline personality disorder
First, you might educate yourself to learn everything you can about borderline personality disorder, its symptoms, and effective treatments. A wealth of stigma and misinformation exists, so finding credible resources is important. NAMI has published common myths and facts about borderline personality disorder if you’re looking for a place to start.
If your family or partner has BPD, attending family or couples therapy together could help strengthen your bonds and teach you both helpful coping strategies for communication, connection, and crisis response.
In the end, it’s the choice of the individual with borderline personality disorder whether or not to attend therapy or seek other treatments for their condition. However, it could be beneficial for you as their loved one to gently encourage them to seek or stick with treatment long-term. Knowing that they have your support through the process could help them start or stay the course.
Finding a balance between supporting your loved one and caring for yourself can be crucial. This can look like setting and enforcing boundaries related to your space, belongings, body, and time. for one. If you feel you could benefit from support with this or another aspect of loving someone with borderline personality disorder, speaking to a therapist yourself may be beneficial.
Counseling options for mental health
If you experience trouble maintaining healthy relationships, feelings of emptiness, an intense fear of abandonment, poor impulse control, and/or other symptoms of borderline personality disorder, you might consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, online counseling for BPD could represent a more convenient option.
A recent study suggests that clients attending DBT treatments online had a higher attendance rate than those in a traditional in-person clinical environment.
Overall, the study also suggests that online DBT treatments can be as effective as in-person options for treating a variety of conditions, from BPD to depression to bipolar disorder.
If you're interested in trying DBT or another form of counseling online, you might consider signing up for a platform like BetterHelp for individuals or Regain for couples. Both platforms offer a growing pool of over 35,000 licensed therapists specializing in various mental health challenges. You can get matched with one who suits your needs and preferences and then meet with them via phone, video call, and/or in-app messaging from the comfort of your home.
Takeaway
Borderline personality disorder is a mental illness that can come with challenging and emotionally distressing symptoms. Mental health counseling with an online or in-person therapist may help reduce the chances of a psychiatric hospital visit in clients with personality disorders. If you're ready to explore your options, you might consider reaching out to a therapist for compassionate insight and support.
Frequently Asked questions (FAQs)
Below are a few frequently asked questions and answers about BPD.
Can you self-treat BPD?
Can BPD be treated with medication?
Medication may benefit those with borderline personality disorder experiencing a co-occurring mental health condition. For example, anxiety or depression medications or antipsychotics may be beneficial in some cases. However, talk to a general medical practitioner or psychiatrist before starting, stopping, or changing medication.
Please note that BetterHelp does not prescribe or discuss medication. Consult a qualified medical professional if you want to try medication for your symptoms.
Can BPD be cured without therapy?
Studies suggest that recovery from BPD is possible with treatment like DBT. However, it may not be linear, and re-addressing therapeutic approaches after treatment may be beneficial to help reduce the chance of symptoms reappearing.
How long does therapy for BPD take?
The length of treatment for borderline personality disorder depends on your program and individual circumstances. Many individuals find it beneficial to try a structured therapy like DBT, which can last for around 20 sessions. Afterward, you might try intermittent or sustained treatment with a licensed therapist.
Why do therapists find it difficult to treat borderline personality disorder?
Therapy may effectively help address borderline personality disorder symptoms. However, this mental illness has many stigmas and myths associated with it, which may cause unfair bias. Finding a compassionate therapist specializing in personality disorders and trauma may benefit you. If you face unkind, aggressive, or targeted harm from a professional, you should typically leave your sessions and find a new provider. Therapy may not be effective unless you feel safe, validated, and respected by your provider.
What can cause borderline personality disorder episodes?
An individual might experience heightened symptoms or emotions regarding several types of stimuli or situations, including but not limited to the following:
- Real or imagined abandonment
- Setbacks in one's personal life, such as the loss of a job
- Use of substances
- Risky behaviors
- Rejection or criticism
- Conflict
Therapy can be an effective way to help people with borderline personality disorder to improve relationships, control intense emotions, and accept challenging situations.
What is the best form of therapy for borderline personality disorder?
DBT is often seen as the gold standard for borderline personality disorder and is a well-studied treatment for this illness. DBT is a structured form of therapy that can be attended in individual, family, or group settings.
Are you born with borderline personality disorder?
How do you calm down with BPD?
If you are experiencing emotional dysregulation, you can try the following relaxation techniques:
- Taking a warm bath
- Taking a walk in nature
- Trying self-soothing skills from DBT
- Practicing Mindfulness
- Exercising
- Talking to a friend
- Playing with a pet
- Writing poetry or journaling
- Eating a healthy meal
- Sleeping
- Talking to a therapist
- Calling a crisis line
- Distracting yourself
What happens if borderline personality disorder is left untreated?
If borderline personality disorder is left untreated, the individual diagnosed may not know which skills to use to manage their symptoms and experience benefits. Symptoms like self-harm, suicidal thoughts, splitting, or risky behaviors might be more common in those who have not attended therapy or are not using coping mechanisms. If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.
Is BPD a psychotic disorder?
Are people with BPD intelligent?
Borderline personality disorder does not affect intellectual intelligence.
Do therapists hate people with BPD?
A therapist should not express hate toward a client or their mental health condition. Mental health professionals can help people with borderline personality disorder control intense emotions, treat specific symptoms, improve relationships, and mitigate self-destructive behavior. Find a new provider if you face discrimination, unkindness, or bias from a licensed therapist due to your diagnosis or symptoms. Although stigma exists, research and education can reduce these beliefs in communities.
Can a person with BPD love?
Yes, a person with borderline personality disorder can form close emotional bonds and may actively seek them. However, borderline personality disorder often includes interpersonal challenges as diagnostic criteria, which can include difficulty forming healthy bonds, feeling loved, or remembering how someone has treated you in the past. It can also be challenging for a person with borderline personality disorder to trust within a relationship. In these cases, relationship and individual therapy may be beneficial.
Does BPD go away with age?
If left untreated, borderline personality disorder may worsen or stay the same over time. Many people find that borderline personality disorder symptoms can be reduced through an effective treatment plan with a licensed therapist specializing in personality disorders or trauma.
You may see a reduction in symptoms after age 25 if you are a young adult or teen experiencing borderline personality disorder symptoms, as the emotional control center of the brain tends to be fully formed around that age. However, seeking professional care can still be essential. Consult with a licensed provider for further guidance.
How can therapy help people with borderline personality disorder (BPD) manage emotional disturbances and improve their overall mental health?
Therapy provides structured support and coping strategies that help individuals with BPD manage emotional disturbances, fostering better emotional regulation and improved mental health. Techniques like Dialectical Behavior Therapy (DBT) are particularly effective in treating BPD.
What are the common emotional disturbances associated with BPD, and how can therapy address these challenges?
Common emotional disturbances in BPD include intense mood swings, impulsivity, and fear of abandonment. Therapy, especially evidence-based approaches like DBT, helps individuals develop healthier ways to manage these emotions, leading to more stable and positive mental health outcomes.
What are the key characteristics of borderline personality disorder (BPD), and how do they contribute to emotional disturbance?
BPD is characterized by intense emotional disturbances, including mood swings, fear of abandonment, and impulsivity. These challenges can significantly impact an individual's mental health and relationships.
How does therapy help people with BPD gain control over their emotional disturbances?
Therapy, particularly Dialectical Behavior Therapy (DBT), can help people with BPD gain control over their emotions by teaching skills like emotional regulation, distress tolerance, and interpersonal effectiveness.
What makes certain therapies more effective in treating BPD compared to others?
Therapies like DBT are specifically designed to address the unique challenges of BPD, making them more effective. They focus on developing practical skills to manage emotional disturbances.
How can effective treatment for Borderline Personality Disorder (BPD) improve overall mental health and emotional control?
Effective treatment for BPD, including therapy and sometimes medication, can lead to significant improvements in emotional control, reducing the frequency and intensity of emotional disturbances and enhancing overall mental health.
What role do emotional disturbances play in the daily life and mental health of someone with BPD?
Emotional disturbances in BPD can lead to unpredictable reactions, strained relationships, and difficulty maintaining stability in daily life. Understanding and managing these emotions is crucial for improving mental health.
How can individuals with BPD work with therapists to develop more effective coping strategies for emotional control?
By working closely with therapists, patients with BPD can learn and practice coping strategies tailored to their needs, helping them gain better control over their emotions and improve their overall quality of life.
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